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Recurrent Bladder Cancer
Current Clinical Trials
The prognosis for any patient with progressive or recurrent invasive bladder
cancer is generally poor. Management of recurrence depends on prior therapy,
sites of recurrence, and individual patient considerations. Treatment of new
superficial or locally invasive tumors that develop in the setting of previous
conservative therapy for superficial bladder neoplasia has been discussed
earlier in this summary. Recurrent or progressive disease in distant sites or
after definitive local therapy has an extremely poor prognosis, and clinical
trials should be considered whenever possible.
In patients with recurrent transitional cell carcinoma, combination
chemotherapy has produced high response rates with occasional complete
responses seen.[1,2] Results from a randomized trial that compared M-VAC
(methotrexate, vinblastine, doxorubicin, and cisplatin) with single-agent
cisplatin in advanced bladder cancer show a significant advantage with M-VAC in
both response rate and median survival.[3] The overall response rate with M-VAC in this cooperative group trial was 39%. Other chemotherapy agents that
have shown activity in metastatic bladder cancer include: paclitaxel,
ifosfamide, gallium nitrate, gemcitabine, and pemetrexed. Ifosfamide, gallium, and pemetrexed have
shown limited activity in patients previously treated with cisplatin.[4-11]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent bladder cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
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Sternberg CN, Yagoda A, Scher HI, et al.: Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced transitional cell carcinoma of the urothelium. Efficacy and patterns of response and relapse. Cancer 64 (12): 2448-58, 1989.
[PUBMED Abstract]
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Harker WG, Meyers FJ, Freiha FS, et al.: Cisplatin, methotrexate, and vinblastine (CMV): an effective chemotherapy regimen for metastatic transitional cell carcinoma of the urinary tract. A Northern California Oncology Group study. J Clin Oncol 3 (11): 1463-70, 1985.
[PUBMED Abstract]
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Loehrer PJ Sr, Einhorn LH, Elson PJ, et al.: A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 10 (7): 1066-73, 1992.
[PUBMED Abstract]
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Roth BJ: Preliminary experience with paclitaxel in advanced bladder cancer. Semin Oncol 22 (3 Suppl 6): 1-5, 1995.
[PUBMED Abstract]
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Witte RS, Elson P, Bono B, et al.: Eastern Cooperative Oncology Group phase II trial of ifosfamide in the treatment of previously treated advanced urothelial carcinoma. J Clin Oncol 15 (2): 589-93, 1997.
[PUBMED Abstract]
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Einhorn LH, Roth BJ, Ansari R, et al.: Phase II trial of vinblastine, ifosfamide, and gallium combination chemotherapy in metastatic urothelial carcinoma. J Clin Oncol 12 (11): 2271-6, 1994.
[PUBMED Abstract]
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Pollera CF, Ceribelli A, Crecco M, et al.: Weekly gemcitabine in advanced bladder cancer: a preliminary report from a phase I study. Ann Oncol 5 (2): 182-4, 1994.
[PUBMED Abstract]
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Seidman AD, Scher HI, Heinemann MH, et al.: Continuous infusion gallium nitrate for patients with advanced refractory urothelial tract tumors. Cancer 68 (12): 2561-5, 1991.
[PUBMED Abstract]
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Roth BJ: Ifosfamide in the treatment of bladder cancer. Semin Oncol 23 (3 Suppl 6): 50-5, 1996.
[PUBMED Abstract]
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Bajorin DF: Paclitaxel in the treatment of advanced urothelial cancer. Oncology (Huntingt) 14 (1): 43-52, 57; discussion 58, 61-2, 2000.
[PUBMED Abstract]
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Sweeney CJ, Roth BJ, Kabbinavar FF, et al.: Phase II study of pemetrexed for second-line treatment of transitional cell cancer of the urothelium. J Clin Oncol 24 (21): 3451-7, 2006.
[PUBMED Abstract]
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